Left ventricular non-compaction (LVNC) is a rare congenital cardiomyopathy defined by the persistence of excessive trabeculations and deep intertrabecular recesses within the left ventricular myocardium. Initially described as a distinct pathological entity in the 1980s, LVNC has since been associated with heart failure, ventricular arrhythmias, and thromboembolic complications [1][2].

Despite growing awareness in high-income countries, LVNC remains poorly recognized in sub-Saharan Africa. This underdiagnosis is largely explained by limited access to cardiac magnetic resonance imaging (MRI), frequent diagnostic confusion with other cardiomyopathies, and insufficient training in standardized echocardiographic criteria [3]. As a result, many patients are diagnosed late, often after the onset of advanced heart failure or sudden cardiac death.

We report a case of LVNC diagnosed in Brazzaville, Republic of Congo, illustrating the diagnostic value of transthoracic echocardiography in a resource-limited setting and emphasizing the importance of integrating imaging findings with clinical presentation and family history.

A 50-year-old female teacher was admitted to the Cardiology Department B of the University Hospital of Brazzaville in November 2025 for progressive dyspnea. Symptoms had started four months earlier with exertional breathlessness and gradually worsened, culminating in orthopnea and NYHA class IV dyspnea. She also reported intermittent palpitations but denied syncope.

Her medical history included arterial hypertension diagnosed one year earlier and treated with amlodipine. Family history was remarkable: her mother and two siblings had died suddenly after developing heart failure, without prior etiological evaluation.

On admission, the patient was tachycardic (104 bpm) with blood pressure of 140/90 mmHg and oxygen saturation of 97% on room air. Cardiac examination revealed a protodiastolic gallop rhythm and bilateral pulmonary crackles. No peripheral edema was noted.

Chest radiography showed cardiomegaly with a cardiothoracic ratio of 58% and signs of pulmonary venous congestion. Electrocardiography demonstrated sinus rhythm with complete left bundle branch block.

Transthoracic echocardiography revealed non-dilated cardiac chambers and severe left ventricular systolic dysfunction with an ejection fraction of 34%. The myocardium displayed a characteristic two-layered appearance, with a thin compacted layer and a thick non-compacted layer containing prominent trabeculations, predominantly at the apex and lateral and inferior walls. The non-compacted to compacted myocardial ratio measured 2.6 at end-systole, assessed in the parasternal short-axis view, fulfilling echocardiographic criteria for LVNC.

Cardiac MRI (Figure 1), performed subsequently, confirmed extensive trabeculations of the left ventricle with preserved right ventricular function and absence of significant late gadolinium enhancement. Laboratory tests were unremarkable. Genetic testing was not available.

The patient was treated with diuretics, an angiotensin-converting enzyme inhibitor, a sodium-glucose cotransporter-2 inhibitor [4], and anticoagulation during hospitalization. Clinical status improved rapidly, with dyspnea decreasing to NYHA class II. She was discharged after ten days and remains under regular follow-up. Family screening has been initiated.

Figure 1.Cardiac magnetic resonance imaging (four-chamber view on left and two-chamber view on the right) confirming extensive left ventricular trabeculations predominantly affecting the apex and lateral wall with relative sparing of the interventricular septum, characteristic of left ventricular non-compaction. Images demonstrate near-global hypokinesis and absence of significant delayed myocardial enhancement.

This case highlights several important aspects of LVNC diagnosis and management in sub-Saharan Africa.

Left ventricular non-compaction is likely underdiagnosed in sub-Saharan Africa. This case demonstrates that, even in the absence of cardiac MRI, appropriate use of transthoracic echocardiography combined with careful clinical and familial assessment can lead to reliable diagnosis. Strengthening echocardiographic training and awareness is essential to improve detection and outcomes of LVNC in resource-limited settings.

Written informed consent was obtained from the patient for publication of this case report and accompanying images.